Efficacy of isobutylamido thiazolyl resorcinol for prevention of laser-induced post-inflammatory hyperpigmentation: A randomized, controlled trial.

BACKGROUND: Q-switched (QS) Nd: YAG laser is one of the treatment options for solar lentigines (SLs). However, the incidence of post-inflammatory hyperpigmentation (PIH) is a common complication, especially in dark-complexioned skin. Isobutylamido thiazolyl resorcinol (ITR) has been reported as a preventive modality for ultraviolet B (UVB)-induced hyperpigmentation. AIMS: This study aims to evaluate the efficacy and safety of ITR for the prevention of laser-induced PIH. PATIENTS/METHODS: A randomized, evaluator-blinded study including 24 subjects with SLs was conducted. Three SLs of each patient were randomized into three groups, which were to apply ITR twice daily, once daily, and no application for 2 weeks. Thereafter, 532-nm QS Nd: YAG laser was performed. Incidence of laser-induced PIH, relative melanin index (RMI), mean luminance score (L*), hyperpigmentation score, and adverse events were recorded for 2 months post-laser. RESULTS: The incidence of PIH at the 4th week after laser treatment was significantly lower in the ITR twice-daily group compared to the no-application group (20.83% vs. 50%, p = 0.028). There was no statistically significant difference in RMI, mean L*, and hyperpigmentation score between treatments at all visits. No serious adverse events were reported regarding ITR application and laser treatment. CONCLUSION: Two-week application of ITR prior to QS: Nd YAG laser treatment may potentially reduce the incidence of PIH. A longer duration of application, including after the laser procedure, may be more beneficial for the prevention of laser-induced PIH.

Efficacy of Botulinum Toxin Type A for Prevention of Post-Mastectomy Scar in Transmen: A Prospective, Randomized Study.

BACKGROUND: Subcutaneous mastectomies in transmen have been gaining popularity. However, post-operative scars are an inevitable consequence. Recently, Botulinum neurotoxin A (BoNT-A) has shown positive effects in scar prevention. The objective of this study is to investigate the effectiveness of BoNT-A in scar prevention. METHODS: Fifteen patients who had undergone subcutaneous mastectomy were included. At 14 days post-surgery, either incoBoNT-A or a placebo was injected into the scar on each side. The primary outcome assessment measured the scar's severity using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). The secondary outcome assessment evaluated the scar's color using a standard measurement device. Outcome assessments were conducted until 6 months post-surgery. RESULTS: There were significantly lower VSS scores in the BoNT-A group compared to the placebo at the end of the study (7.43 ± 0.26 vs. 8.82 ± 0.26, p < 0.001). The objective assessment revealed a statistically significant decrease in redness values in the BoNT-A group compared to the placebo at 3 and 6 months. CONCLUSION: BoNT-A has demonstrated effectiveness in scar prevention by reducing the severity of postoperative scar formation and improving overall scar appearance.

A comparative study of pain perception during the microfocused ultrasound procedure between topical anesthesia and combined topical anesthesia with forced air cooling.

BACKGROUND: The experience of pain during microfocused ultrasound with visualization (MFU-V) treatment is common and crucial for dictating patient satisfaction and retention. OBJECTIVE: To compare the pain perception during the MFU-V procedure between two pain reduction methods (topical anesthesia alone versus combined topical anesthesia with forced air cooling). MATERIALS AND METHODS: This was a prospective, single-blinded, randomized controlled trial. A square area on the inner side of both arms of healthy volunteers was marked as an experimental site and randomly assigned to receive each pain reduction method: topical anesthesia or combined topical anesthesia with forced air cooling. Thereafter, MFU-V was performed with a 4.5 MHz, 4.5 mm transducer (10 lines, 0.9 J) followed by a 7 MHz, 3.0 mm transducer (10 lines, 0.3 J). The visual analog scale (VAS) for pain was measured immediately after 4.5 mm transducer (T1a), immediately after 3.0 mm transducer (T1b), and after the entire procedure (T2). RESULTS: Twenty-one participants with a mean (SD) age of 34.67 (±6.18) years were enrolled. The mean (±SD) pain score of combined topical anesthesia with forced air cooling-treated area was 5.40 (±1.64), 4.80 (±1.63), and 5.40 (±1.56) at T1a, T1b, and T2, respectively. The mean pain score for topical anesthesia-treated areas was 5.89 (±1.45), 5.00 (±1.72), and 5.76 (±1.67) at T1a, T1b, and T2, respectively. There were no statistically significant differences in the pain perception between the two methods. CONCLUSION: The addition of forced air cooling is not beneficial for pain reduction during the MFU-V procedure because its temperature reduction effect cannot be delivered to the deep parts of the skin, which is the target site of MFU-V.

The role of topical capsaicin gel in pain management during microfocused ultrasound treatment for neck laxity.

BACKGROUND: The transient receptor potential vanilloid 1 (TRPV1) provides a heat and pain sensation (nociception). Capsaicin, a TRPV1 agonist, has been shown to induce a refractory period in the nerve terminal expressing TRPV1 and create long-term nerve terminal defunctionalization. OBJECTIVE: To evaluate the efficacy of capsaicin for pain reduction during microfocused ultrasound with visualization (MFU-V) treatment. METHODS AND MATERIALS: A randomized, split-side study including 24 subjects was conducted. A combined 0.025% capsaicin gel and topical anesthetic were randomly applied on one side of the neck, and a topical anesthetic monotherapy was applied on the contralateral side for 30 min before MFU-V treatment. Pain score (visual analog scale, 0-10) was evaluated at T1 (before MFU-V), T2a (after the 4.5-mm transducer treatment), T2b (after the 3.0-mm transducer treatment), and T3 (after the entire treatment). Side effects were recorded. RESULTS: Mean pain scores at T2a for combined and single regimens were 5.19 (±2.26) and 6.91 (±1.72), respectively (p < 0.001). The capsaicin-treated side had a lower pain score at T2b and T3 (p < 0.001). Redness was longer on the capsaicin-treated side (112.67 vs. 10.68 min, p < 0.001). No other adverse events including contact dermatitis were reported. CONCLUSION: A single application of a combined 0.025% capsaicin gel with topical anesthesia produces a significantly lesser pain score during the MFU-V treatment. Defunctionalization of TRPV1 may explain the alleviation of painful sensations caused by heat from MFU-V.

Chronic kidney disease is potentially an independent prognostic factor for death in Stevens-Johnson syndrome and toxic epidermal necrolysis patients.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are mucocutaneous conditions associated with high mortality and morbidity. Although several prognostic factors have been proposed, some may have yet to be identified. A 14-year retrospective cohort study of patients with SJS/TEN was conducted at a university-based hospital in Bangkok, Thailand, to explore additional prognostic factors for mortality of patients with SJS/TEN. Medical records of all patients aged ≥18 years who were diagnosed with SJS, SJS-TEN overlap, or TEN between 2007 and 2020 were reviewed. Univariate and multivariate analyses were performed to examine associations between death and potential prognostic factors. A total of 76 patients with a mean age of 52 years were enrolled. Among them, 46, 15, and 15 patients were diagnosed with SJS, SJS-TEN overlap, and TEN, respectively. Overall, 10 patients deceased, marking a mortality rate of 13.2%. Based on an algorithm for assessment of drug causality for epidermal necrolysis, drug was the major cause of disease (96.1%). Allopurinol and trimethoprim/sulfamethoxazole were the most frequent culprit drugs. Univariate analysis revealed nine prognostic factors related to death, i.e., age, malignancy, chronic kidney disease (CKD), coronary artery disease, heart rate >120 beats/min, diagnoses of SJS-TEN overlap and TEN, blood urea nitrogen (BUN) >10 mmol/L, hemoglobin <10 g/dL, and serum albumin <2 g/dL. Causality with regard to drug, drug notoriety, time interval from drug intake to onset of reaction, and timing of culprit drug withdrawal were not significantly associated with death. Four independent prognostic factors for mortality were identified from multivariate analysis, i.e., TEN (risk ratio [RR] 8.29, 95% confidence interval [CI]: 2.71-25.38), malignancy (RR 3.34, 95% CI: 1.68-6.69), BUN >10 mmol/L (RR 3.02, 95% CI: 1.28-7.14), and early-stage CKD (RR 4.81, 95% CI: 2.49-9.28). Our findings suggest that CKD is an independent prognostic factor for mortality of patients with SJS/TEN besides those from the SCORTEN.

Incobotulinum Toxin Type A for Treatment of Ultraviolet-B-Induced Hyperpigmentation: A Prospective, Randomized, Controlled Trial.

Incobotulinum toxin A (IncoBoNT-A) is effective in preventing ultraviolet B (UVB)-induced hyperpigmentation. This prospective, randomized, controlled study aimed to evaluate the effect of IncoBoNT-A on the treatment of UVB-induced hyperpigmentation in 15 volunteers. Five hyperpigmentation squares (2 × 2 cm) were induced by local UVB on the abdomen at baseline. At Day 7, each site was randomized to receive no treatment (control), normal saline, or intradermal IncoBoNT-A injection with 1:2.5, 1:5, and 1:7.5 dilutions (12, 6, and 4 units, respectively). The mean lightness index (L*), hyperpigmentation improvement score evaluated by blinded dermatologists, and participant satisfaction scores were obtained at Days 21, 28, and 35. At Day 21, improvements in mean L* of 1:2.5, 1:5, and 1:7.5 IncoBoNT-A-treated, saline-treated, and control sites were 14.30%, 12.28%, 6.62%, 0.32%, and 4.98%, respectively (p = 0.86). At Day 28, the improvement in mean L* in IncoBoNT-A-treated groups was superior to that in the other groups. In terms of the hyperpigmentation improvement score, 12 participants (80%) experienced better outcomes with the IncoBoNT-A-injected site compared with the other sites. IncoBoNT-A, especially at higher concentrations, showed some positive effects on the treatment of UVB-induced hyperpigmentation. This may serve as an adjuvant treatment for hyperpigmentary conditions that are aggravated by UVB.

Study of botulinum toxin type A for the treatment of ultraviolet B-induced hyperpigmentation: A prospective, randomized, controlled trial.

BACKGROUND: Botulinum toxin type A (BTX-A) has been used experimentally under various dermatological conditions. Recent studies have revealed a preventive effect of BTX-A against ultraviolet B (UVB)-induced skin hyperpigmentation. OBJECTIVE: We examined the effect of BTX-A for the treatment of UVB-induced hyperpigmentation in humans. MATERIAL AND METHODS: A prospective, double-blind, randomized controlled trial was conducted. UVB irradiation induced five separate hyperpigmented squares on the abdomen. Seven days after irradiation, all squares were randomly assigned to five intervention groups: control, 0.9% normal saline injection, 12 units (1:2.5), 6 units (1:5), and 4 units (1:7.5) of onabotulinum toxin injections. The lightness index (L*), hyperpigmentation improvement score rated by a blinded physician, and participant satisfaction scores were obtained at 14, 21, and 28 days after injection. RESULTS: Fifteen participants (mean age 36.9 years, Fitzpatrick skin types III-IV) completed the study. The BTX-A (1:2.5)-treated site had a lower degree of hyperpigmentation at all time points, as measured by mean L* and hyperpigmentation improvement scores. However, there were no statistically significant differences between the groups. Participants were most satisfied with the control site. CONCLUSION: Intradermal BTX-A injection had no therapeutic effect on UVB-induced hyperpigmentation. However, the role of BTX-A injections in the treatment of other hyperpigmentary conditions requires further elucidation.

Biological therapy in Psoriasis: An emphasis on its dermatologic adverse events.

OBJECTIVE: To report an overview of dermatologic adverse events (AEs) related to biologics used for psoriasis and compare common dermatologic AEs across different biologic classes. DATA SOURCE: A comprehensive search in MEDLINE via PubMed from inception through June 9, 2021, was conducted. STUDY SELECTION: The selection process was performed independently by two reviewers. Studies were eligible if patients were diagnosed with plaque-type psoriasis, were treated with biologics, and had ≥ 1 dermatologic AE. RESULTS: A total of 1023 records were identified, and 127 studies were included. The incidence of dermatologic AEs was 4.17% for tumor necrosis factor-α (TNF-α) inhibitors, 9.49% for interleukin (IL)-12/23 inhibitor, 12.40% for IL-17 inhibitors, and 7.37% for IL-23 inhibitors. Biologic-related dermatological AEs can be classified into allergic skin reactions, inflammatory skin diseases, skin infections, skin neoplasms, and miscellaneous AEs. An evident class effect was observed. Skin neoplasms (1.45%), mainly nonmelanoma skin cancer (1.36%), predominated among TNF-α inhibitors. Allergic skin reactions (6.25%) were frequently reported with IL-12/23 inhibitor. During treatment with IL-17 inhibitors, skin infections (5.01%) were common, and the most common was driven by mucocutaneous candidiasis (4.85%). Inflammatory skin disease (2.32%), mainly eczematous eruptions (0.84%), dominated in IL-23 inhibitors. CONCLUSIONS: A predominance of specific dermatologic AEs appears in distinct biologic classes due to their different specific targets of action. Further study is needed to understand the mechanisms of these potential AEs, which will help in their management.

The effectiveness of commercial household ultraviolet C germicidal devices in Thailand.

Ultraviolet C (UVC), or ultraviolet germicidal irradiation (UVGI), is known for its effective air, water, and surface disinfectant properties. With the rise of global awareness about public sanitation and personal hygiene due to the emergence of the current coronavirus disease 2019 pandemic, several applications of UVC were introduced to the commercial market. The present experimental study aimed to evaluate the effectiveness of commercial household UVC germicidal devices for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) inactivation. Ten UVC devices were included in the study comprising of 7 low-pressure mercury lamps (LPMLs) and 3 UVC- light-emitting diodes (LEDs). Considering applications, 3 were handheld UVGI surface disinfection equipment, 4 were UVGI disinfection chambers, and 3 were movable UVGI air and surface purifiers. To determine SARS-CoV-2 inactivation performance, UVC irradiance (mW/cm2) was measured 3 times repeatedly at distance and duration corresponding to manufacturers' usage instructions. The required UVC dosage could not be achieved by either of UVC-LED devices (1 handheld UVGI surface disinfection equipment and 2 UVGI disinfection chambers). Five of seven LPMLs can sufficiently emit UVC irradiance for SARS-CoV-2-inactivation. A lack of standardization in the distance and cycle duration for each UVC application was observed. Standard usage guidelines for UVC devices are required to improve the effectiveness of UVC irradiance for SARS-CoV-2 inactivation as well as to minimize the potential side effects of UVC.